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This week, Congressman Paul Ryan decisively dashed Republican Party hopes with a firm “no” to a 2012 presidential race. America should breathe a sigh of relief that the steely blue-eyed wonder boy from Wisconsin has declined to attempt to imprint his vision on an unsuspecting America, for the society Ryan envisions is not one a majority of Americans would welcome, or even recognize, if the ramifications of his philosophy were better understood.

The 41-year-old Ryan is widely regarded as an intellectual policy wonk, and his plan to balance the federal budget in 30 years — which he dubbed “The Path to Prosperity” — has been heralded by the GOP as a courageous and bold attempt to bring out-of-control federal spending to a halt. The seven-term congressman is now chairman of the House Budget Committee and his far-reaching budget plan — deep cuts to entitlements, coupled with significant tax cuts — passed the Republican House and was derailed in the U.S. Senate.

“They’ve made Paul Ryan into a heartthrob,” said the senior editor for the conservative National Review.

Indeed they did. Ryan’s web video — which blitzed the broadcast media earlier this year — features him walking alone down long, silent corridors of power, creating a visual image for the verbal spin of the brave young hero summoning the courage to confront the partisan follies and internecine warfare of Washington D.C.

The problem, though, is Ryan’s vision for America includes a most-unAmerican idea of a entrenched inequality for basic human needs. In Ryan’s America, you will only be entitled to receive the medical care you can afford. His plan would implement that vision slowly, by degrees, with fundamental changes to the structure of both Medicare and Medicaid to begin in 2022.

Ryan’s plan calls for privatizing Medicare and providing a voucher — though Ryan prefers the term “premium support payment” — to an insurance plan selected by the Medicare recipient. From the moment the plan takes effect, in 2022, the out-of-pocket costs of new Medicare recipients — those now under 55 years of age — would be double those of recipients still enrolled in the traditional Medicare plan.

That doubling will mean new Medicare beneficiaries will pay $12,500 out of pocket for health-care benefits, compared to $5,630 for recipients in the traditional Medicare system. These numbers have been confirmed by both the Congressional Budget Office and the Kaiser Family Foundation, a private, nonprofit health policy research foundation.

Each year, under Ryan’s plan, more of the cost of the Medicare insurance premium will be shifted onto the beneficiary. His plan ties annual increases for the federal Medicare voucher to the Consumer Price Index, which lags significantly behind the 7 to 10 percent annual increases in health-care costs.

His plan would, as intended, reduce federal spending for Medicare by providing future beneficiaries with a fixed amount to purchase a private insurance premium, leaving them on the hook for significantly larger out-of-pocket payments each year to be determined solely by private insurers, until, eventually, the voucher will become more like a discount coupon.

Ryan’s plan includes no attempt to contain the nation’s unsustainable soaring health-care costs; his vision is to simply transfer the burden for paying for them to the Medicare beneficiary. For most middle- and upper-income seniors, that may mean a shorter vacation, or fewer rounds of golf.

But what happens when, over time, the out-of-pocket costs of premiums and co-pays inevitably outpace many Medicare beneficiaries’ ability to pay? Paying for medical care isn’t, after all, the same as buying a home, a new car, or premium cable channels. Medical care isn’t a consumer product with smaller, cheaper versions available to low-income seniors.

One of Ryan’s fellow GOP stars, House Majority Floor Leader Eric Cantor, revealed the likely result in a speech to a group of physicians in May, reported by The Hill, a congressional newspaper.

The Democrat’s health-care reform law mandates benefits that are too generous, Cantor said. Private health-care plans are already rationing care for profit and should remain free to do so; consumers, then, should try to buy the best health-care coverage they can afford.

“Cantor appeared to go further than Republicans have in the past by acknowledging that not all patients are certain to get optimal healthcare under a system of private insurance,” The Hill reported. “We’re not for everyone having the same outcome guaranteed,” Cantor said.

No medical outcome is guaranteed for anyone. What Cantor really said is that Republicans aren’t for everyone having the same medical care guaranteed. Ryan’s vision of a nation that permits the provision of medical care to be based upon wealth is one I believe most Americans reject.

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